Management of patients with acute myocardial infarction with ischemic stroke
G. Vijayalakshmi1* Arul kumar B2
1Nursing Incharge, Kauvery Heartcity, Trichy, India
2Senior Executive Nursing, Kauvery Heartcity, Trichy, India
*Correspondence: +91 85086 98000;E-mail: nursing.heartcity@kauveryhospital.com
Case Presentation
A 69 years old male, with diabetes and hypertension, had complaints of giddiness since 04:00 pm on 05.01.2023, associated with slurring of speech and weakness of the right upper and lower limb. He initially went to a hospital that referred him to Kauvery Heartcity for further management.
Chief complants
- Giddiness
- Slurring of speech
- Weakness of right upper and lower limb
Vital Signs
- On examination,
- BP – 100/60mm Hg, HR – 96 bpm, RR – 20/mt, SpO2 – 98%
- CNS – Right sided hemiplegia
- RS – BAE, P/A – Soft
- CVS – Sí¢â€šÂ Sí¢â€šâ€š normal
Investigation
- ECG – ST elevation in inferior Leads
- ECHO – Mild LV Dysfunction
- Urea – 28mg/dl, Creatinine – 1.36mg/dl
- Hemoglobin – 11.4
- Serology – Non reactive
- MRI Brain – Acute infarct left MCA territory. Age related cerebral atrophy.
Diagnosis
- Coronary Artery Disease
- Acute Coronary Syndrome – Acute Inferior Wall Posterior Wall Myocardial Infarction (ACS IW PW MI)
- Mild LV Dysfunction
- Right Hemiplegia consequent of Acute Infarct, Left MCA territory
- Type II Diabetes Mellitus
- Systemic Hypertension
ECG: 1
ECG: 2
ECG: 3
Coronary Angiogram
CAG on 05.01.23 – Double vessel disease.
Primary PTCA with stenting was done to RCA (05.01.23)
CAG Report
MRI Report
CT scan Report
ECHO Report
Treatment
In view of above findings patient was diagnosed to have ACS – IW PW MI (Window period 4 h) and advised primary PCI for further management. After an informed written consent patient was taken up for CAG on 05.01.23, which revealed double vessel disease. He underwent primary PTCA with stenting to proximal to Mid RCA and Mid to Distal RCA on 05.01.23 with successful results. There were no procedural and post procedural complications and his post procedural period was uneventful.
Neurologist opinion was obtained in view of slurring of speech with weakness ad giddiness. His MRI brain revealed acute infarct in left MCA territory age related cerebral atrophy. His multi slice CT brain revealed no demonstrable acute infarct/hemorrhage/SOL. Old calcified granuloma in external capsule age related cerebral atrophy.
Patient was treated with antiplatelets, anticoagulants, diuretics, PPI and other supportive measures.
Nature of the disease and risk of restenosis were well explained to patient’s attenders. Patient condition is improved and is being discharged in a stable state.
Nursing Management of MI with Stroke
- Assess mental status and level of consciousness
- Observe for neurological deficits with frequent and serial neurological assessments
- Measure and monitor pupil size
- Assess breathing
- Monitor vital signs
- Assess higher function like speech, memory and cognition
- Provide a quiet environment with the head of the bed elevated
- Elevate bed rails to prevent falls
- Leave the nurse bell button at the side of the bed in case the patient needs to go to the bathroom
- Prevent constipation and straining with stool softeners
- Watch for seizures
- Observe for changes in mood
- Provide deep vein thrombosis (DVT) prophylaxis
- Ability to swallow
- Ability to void urine
- Muscle strength and mobility
- Mood and behavior
Discharge Advice given
- Education regarding the causes of stroke
- Education regarding modifiable risk factors for stroke
- Education regarding blood pressure and glucose management
- Education regarding healthy dietary intake
- Emphasizing medication compliance
- Ensuring patient’s and caregivers understand potential complications of therapy, especially bleeding, if they are discharged on blood thinners
Health Education given
- Eat healthy foods
- Do not lead a sedentary life style
- Observe compliance with medications
- Follow up with a clinician
- Do not smoke
- Control blood pressure, blood glucose and hyper lipidermia
- Participate in regular exercise
Discussion
When the blood supply to the brain is interrupted causing a part of the brain to die it’s called a stroke or “Brain Attack”.
Stroke is similar to an Acute Myocardial Infarction but it affects the blood vessels in the brain instead of the heart.
Discharge Medication
- Tab. Ticagrelor 90 mg 1-0-1
- Tab. Ecosprin 75 mg 0-1-0
- Tab. Aztor 40 mg 0-0-1
- Tab. Gilipride 5 mg 1-0-1
- Tab. Ceftron 250 mg 1-0-1 × 5 days
Recovery
After a stay of 3 days in the hospital, patient became stable with the efficient care of nurses and went home happily with good prognosis.
Ms. G. Vijayalakshmi
Nursing Incharge
Mr. B. Arul kumar
Senior Executive Nursing